Some Antipsychotics Raise Death Risk In Elderly

A large study reveals that some antipsychotic drugs raise the risk of death in the elderly. As we’ve written, such drugs are approved to treat schizophrenia and bipolar disorder; however, they’re often used off-label to treat seniors with dementia. The drugs carry a black box warning that elderly people treated in this way suffer increased risks of death.

A study involving 75,445 patients found that nursing home residents over the age of 65 who take certain antipsychotics are at increased risk for death, said the PharmaTimes. The study, which appears on bmj.com, was conducted by the Harvard Medical School and is the largest of its kind involving U.S. nursing home residents. The research analyzed mortality risks in seniors during a six month period, said PharmaTimes, and assessed mortality risks linked to antipsychotics including Bristol-Myers Squibb/Otsuka’s Abilify (aripiprazole), AstraZeneca’s Seroquel (quetiapine), Eli Lilly’s Zyprexa (olanzapine), Pfizer’s Geodon (ziprasidone), and Johnson & Johnson’s Haldol (haloperidol) and Risperdal (risperidone). Some 6,598 patients died in the six-month period from non-cancer related causes.

The research revealed that patients treated with haloperidol experienced double the risk for death versus patients taking risperidone. Those prescribed quetiapine experienced reduced death risks and the effect of haloperidol was strongest in the initial 40 days of treatment; this remained unchanged a dose adjustment, said PharmaTimes. Nearly half of the deaths—49%—related to circulatory disorders, 10% to brain disorders, and 15% to respiratory disorders.

Although not all antipsychotics carry the same risk for death in the elderly, “clinicians may want to consider this evidence when evaluating … the best approach to treatment of behavioral problems,” the team said, according PharmaTimes.

As we’ve mentioned, in 2003, the FDA required the makers of atypical antipsychotics to re-label them to include warnings regarding their risk of hyperglycemia and diabetes mellitus. In 2005, the FDA also warned that such drugs increased the risk of death among elderly people. PharmaTimes noted that the FDA broadened its warning in 2008 to include conventional antipsychotics.

BMJ pointed out that it remains unclear if the risks differ by drug. The authors concluded that use of these drugs will probably continue, regardless of known issues, due to the “continued growth of the dementia population” and the growing need for intervention, said PharmaTimes.

An accompanying editorial, written by Jenny McCleery from the Oxford NHS Foundation Trust, explained that “the use of any antipsychotic in dementia is undesirable given the increased risk of death and the many other adverse effects of these drugs, in addition to their limited efficacy against target behavioral and psychological symptoms … future research should be pragmatic. It should focus on identifying the key components of non-drug based interventions and on establishing the service structures that can deliver them as simply and efficiently as possible,” said PharmaTimes.